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eye cases: how?

eye cases: how?

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eye cases: how?

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  1. eye cases: how? DR. PRANAV BHAGWAT DR. JIJITH C.R.

  2. HISTORY TAKING • Allow patient to tell story.

  3. Decreased vision Ask for • Onset • Duration • Uni / Bilateral • Distant or near vision • Whether the patient wears glasses • Diurnal variation

  4. Sudden unilateral loss of vision • Acute congestive glaucoma • Acute optic neuritis • Acute iridocyclitis • Retinal detachment • Central retinal artery occlusion • Spasm of retinal artery • Vitreous haemorrhage • Injuries

  5. Sudden bilateral loss of vision • Acute methanol toxicity • Hysteria

  6. Reduced vision in the morning, improved in afternoon • Intermittent corneal edema

  7. Cataract Refractory errors Retinopathy-DM, HT Retinal degenerations and RP Chronic iridocyclitis Chronic simple glaucoma Keratitis K opacities Chorio retinitis Chronic optic neuritis MS Drug toxicity Gradual onset loss of vision

  8. Pain in the eye • Type • Onset • Duration • Diurnal variation • Associated complaints e.g., nausea, vomiting, DV

  9. Severe eye pain • Adhimantha • K abrasions and ulcers • Acute iridocyclitis • Panopthalmitis • Acute glaucoma • Scleritis • Episcleritis

  10. Dull Aching pain • Cases with eye strain

  11. Mild eye pain • Corneal FB • Conjunctival FB • Conjunctivitis

  12. Pain around the eye • Pathology of the lid and lacrimal apparatus (eg: stye)

  13. Redness of the eye

  14. Normal eye lid with normal corrected visual acuity • Conjunctivitis • Keratitis • Corneal ulcer • Arjuna • Episcleritis

  15. Abnormal eye lid with normal corrected visual acuity • Ectropion • Entropion • Stye • Blepharitis

  16. Reduced corrected visual acuity without diplopia • Iritis • ACG • K foreign body • K ulcer

  17. Reduced corrected visual acuity with diplopia • Carvernos sinus thrombosis • Orbital cellulitis • Caratico carvernos fistula

  18. Common causes –red eye.

  19. Photophobia • Acute infective or inflammatory lesion of the anterior segment • Recently operated eyes

  20. Watering of the eyes 1)Excessive lacrimation • Keratitis • Uveitis • Glaucoma 2) Epiphora • Mechanical obstruction to drainage- stricture, punctal stenosis & chronic dacryocistitis • Defective orbicularis action

  21. Discharge • Watery-Mild bacterial infection • Serous -viral • Mucoid -mild conjunctivitis • Mucopurulent & purulent- acute pyogenic infection of anterior segment • Serosanguinous- opthalmia neonatrum

  22. Itching • Allergic disoders- phlycten • Episcleritis • Spring catarrh • Allergic blepharo conjunctivitis

  23. Netra daaha • Pittotklishta • Pittaja abhishyanda • Pitta vidagdha drishti.

  24. Foreign body sensation • Presence of FB • Distorted eye lashes- trichiasis, entropion • Conjunctival concretion, calcification • Contact lenses

  25. Black spots in front of eyes • 1) Stationary K scars, lens opacity • 2) Mobile- Vitreous opacities

  26. Headache • Refractive errors • Improperly corrected refractive errors • Zoster

  27. Haloes around light • 1) Early ACG • 2) Acute mucopurulent conjunctivitis • 3) Early stages of cataract

  28. Photopsiae • Irritative lesions of retina • Impending RD

  29. Diplopia • 1) Unioccular- high K astigmatism, subluxated or dislocated lens • 2) Binocular- Squint

  30. Nyctalopia • Vitamin A deficiency • Retinitis pigmentosa • Pathological myopia • Glaucoma

  31. Occupation • Welders • Black smiths- foreign body in the eye • Farmers- fungal keratitis

  32. Medication • 1) Gentamicin, miotics, Atropin- follicular response • 2) Topical anasthetics for long time- severe corneal reactions • 3) Topical and systemic steroids- K disease, cataract, glaucoma • 4) Thiomersal- allergic conjunctivitis, epithelial Keratitis • 5) Benzalkonium- toxic papillary reaction

  33. Past history • Systemic diseases- diabetis mellitus • Arjuna-HT • Iritis- ankylosing spondylitis

  34. History of previous ocular disease • Childhood squint- lazy eye • Blunt injury- traumatic mydriasis ( could be confused with partial third nerve palsy)

  35. Family history • Chronic glaucoma- the incidence nearly 5 times greater in siblings and children of affected patients

  36. Examination of the function of eye

  37. Visual acuity • Snellen’s chart- 6 mtrs • Wear his distant corretion • One eye at a time • 6/60 - 6/6 • CF at 1 meter • Hand movements • PLPR

  38. Jaeger’s test type • N5 to N48

  39. Visual field • 1) Peripheral field- confrontation or perimeter • 2) Central field by scotometery

  40. Colour vision • Ishiahara chart

  41. Ocular and periocular examination • 1) Head posture- Paralytic squint.

  42. Face • Look for • Asymmetry • Signs of paralysis • Obvious skin changes

  43. Orbit • Inspection and palpation

  44. Eye brows • Look for loss of hair- lepromatous leprosy, myxoedema • Depigmentation

  45. Eye lid • 1) Position of the lid margin in relation to cornea- drooping of lids • 2) Thickness of the lid • 3) Swelling • Localised eg) Stye, chalazion • Generalised- Oedema,ecchymosis

  46. Pakshma mandal • Trichiasis- misdirection of lashes • Distichiasis- double row • Madarosis- scantiness • Matting- conjunctivitis

  47. Shuklamandal (conjunctiva & sclera) • 1) Bulbar conjunctiva a) congestion- ciliary/conjunctival

  48. b) Chemosis- c) Subconjunctival haemorrhage d) Pigmentation e) Nodule